Narrative Medicine

Narrative Medicine Monday: Complaint

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We discussed writer and physician William Carlos Williams’ “Complaint” during a poetry lecture at the first workshop of Harvard’s Media & Medicine program. I was struck by how differently those in the class, mostly clinicians, interpreted this poem.

I saw it as Williams’ manifesto for physicians. Healthcare professionals often feel a calling to their work. Though it is a challenging road, in both training and practice, there is rich meaning inherent in the work we do. Williams at first seems reluctant to move into the dark in the middle of the night, but when he arrives to the patient’s home, he is able to “shake off the cold.” He finds a “great woman / on her side in the bed.” There was discussion as to what Williams meant by “great woman.” Why do you think he used this adjective? Do you find his tone in the poem complementary or otherwise?

There were different thoughts on Williams’ curious use of “perhaps” in the following lines: “She is sick, / perhaps vomiting, / perhaps laboring / to give birth to a tenth child.” These are things that, as her physician, you’d expect him to be clear about. I wonder if the use of “perhaps” is a commentary on medicine itself. Our patients could be suffering, and do, from all kinds of illness and ailments and, though not interchangeable, regardless of their disease, we owe them our attention and compassion.

Williams ends tenderly, a hope for the profession, despite a tone of distancing himself from the situation. These last lines reveal the intimacy that often occurs between healthcare providers and patients. The doctor begins in the chill of midnight, going because he is called, but ends with this moment of compassion. Can you relate to this scene, either as a patient or as a physician?

Writing Prompt: Do you think in today’s world of modern medicine patients and their doctors still connect in the same way as during Williams’ era? How is a house call different from an office visit at a clinic? What do new technologies (email, video visits, chat) offer patients and their medical providers, and how do these interactions limit that relationship? Alternatively, think about the title of this poem. Why do you think Williams called it “Complaint?” Write for 10 minutes.

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Narrative Medicine

Narrative Medicine Monday: Throat

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Gabriel Spera writes of how our body changes in sinister ways in his award winning Bellevue Literary Review poem “Throat.” Spera speaks of how aging can alter a previously cherished reality, in this case, a love of food: “… life takes or twists what we hold most dear, / the heart’s fire of youth swapped for the heartburn / of middle age, which ends each feast at the medicine chest.”

In the midst of these bothersome symptoms, Spera’s friend gets difficult news: “She spoke bluntly, the doctor, as though hiding her chagrin / at all the time they’d wasted chasing red herrings— / ulcers and reflux, bacterial infection. They’d begin / with the chemo right away…” This is a constant fear, a threat with any ailment. During a visit, I often ask patients what they are most concerned about to ensure I’m addressing whatever issue weighs heavily on their own mind. Sometimes I’m surprised at their response, their occupation with a worry I would not have considered in the differential of likely, or even possible, causes. Often there are concerns about the least likely but most serious cause of a symptom: a headache is a brain tumor, a cough is lung cancer, a skin change is melanoma. Most of us have a tendency to worry about the worst case scenario.

In this case, the man is eventually diagnosed with that worst case —cancer. Spera’s lyrical descriptions of the ensuing treatment are infused with detail. The IV bag of chemo: “The tube: a string gone slack without a puppeteer / to tug it, a sleeping viper, a vine, a spill / of vermicelli, a nematode keen to disappear / into the cool earth of his arm…” The radiation is “like a cluster bomb / of atom-sized suns. Then the fallout, the scorched earth / of his flesh, the fatigue, the itch of skin too numb / to scratch.”

The reader is transported into this suffering body, the treatment itself causing “A backlash, a body blow: What stunted the tumor stunned / his muscles, his neck’s whole scaffold rigidized / like leather left to the mercy of the sun…” Within the details of this devastating illness and its treatment lies broader truths. Spera reflects that “Sometimes, what leaves us frees us, and what remains / holds soul enough…” Ultimately, the conclusion is that “despite conflicting evidence, / even the least life is worth what it inflicts.”

Writing Prompt: When there is a recurrence of cancer, the patient questions if “He’d had enough, or rather, no longer had / enough to keep losing chunks of himself, ill-equipped / to envision any future worth suffering further for.” Have you had an illness that caused you to question if you’d had “enough?” Have you had a patient who told you that they’d had enough? What does “enough” mean? Write for 10 minutes.

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Writing

Narrative Medicine Monday: Karyotype

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Poet Rebekah Denison Hewitt is one of Narrative Magazine’s poetry contest winners this year. Her “Karyotype and Other Poems” are a sequence of three poems that reveal different aspects of motherhood, from fetal testing to the fear and risk inherent in parenting.

In “Karyotype,” Hewitt illuminates the process of cell-free DNA extracted from a mother’s blood around ten weeks of gestation, a test that provides genetic information about the fetus. Hewitt’s genetic counselor “begins / to list every disorder / a lab can find in a fetus….” When this relatively new test became available with my third child, despite my medical background, I was still struck, as Hewitt seems, by the wonder of it, these fragments of my baby’s DNA floating through my veins: “The needled blood / from my arm a soup / of genetic code.”

Though Hewitt recalls a high school quiz “matching symptoms to disorder,” there is a turn in her reflection on the soul: “I think souls must exist / in wanted things. Dogs go to heaven, not roaches.”

Hewitt notes there is a calculation to how much information we really want to know: “Just trisomy 21, 18, 13? / Or microdeletions, too?  / My blood contains the risk / of something missing—a malformation / of the head—or worse.” Ultimately, though, she brings the question back to the essentials of what makes us human, beyond that of just our strands of DNA: “What makes this body inside me / more than an animal, clawing its way out…”

Writing Prompt: Hewitt writes about what she learned of some genetic disorders in high school and how she recalled this later when she was getting cell-free DNA testing. Think of something you learned in a science class that, many years later, manifested in an unexpected way in your life: genetics, biology, chemistry. Alternatively, think of a time you had a medical test done and the broader issues (what constitutes a “soul?”) that test might’ve brought up for you. Write for 10 minutes.

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